Overview
The project builds on WHO/UNICEF recommendations of user needs, adapted for Zambia: a ‘diarrhoea treatment kit’ for all new mothers, combining ORS, Zinc and promotion of hand-washing. It follows WHO/UNICEF guidance on using ‘market forces’ and ‘innovative delivery strategies’ to widen access. Following user insights, that 1 litre sachets are not ideal for home-use (a child on average drinks 400ml; the rest must be discarded) and issues mixing and measuring ORS solution in the home, the project designed the package as a 200ml measure with replaceable lid and reduced an existing ORS sachet to 200ml.
Strategically, we aim to provide metrics and learning on a range of innovative ideas, with adaptations/adoption available to other countries, for example, learning from the Coca-Cola distribution model.
Similar problems are typical in Sub Saharan Africa and elsewhere. Globally, diarrhoea is responsible for approximately 15% of childhood deaths; the second leading cause after pneumonia. Similar figures are seen in Zambia in spite of apparent good knowledge of ORS for many years. Zinc as a combined therapy for diarrhoea is not well known. Whilst Zambian health centres serving rural populations distribute ORS free, it may not be in stock and many mothers/carers need to walk long distances and then queue. In Zambia, public sector distribution bottlenecks exist at district level. Zambia’s existing private health sector is one of the smallest in the world (<70 registered pharmacy retail outlets, most in towns). However, in rural communities, bottled soft drinks are readily available – suggesting potential to ‘piggy-back’ on those distribution chains – physically and intellectually.
The COTZ project builds on 3 years of innovative concept development and design involving local and international stakeholders, including 8 months’ co-design with implementation partners in Zambia.
UK charity ColaLife pioneered the concept, with an ‘AidPod’ package, designed to fit into the unused space between crated bottles, with permission from The Coca-Cola Company and its Zambian bottler SABMiller to test this and similar delivery routes in order to explore the following hypothesis:
Piggy-backing essential medicines such as oral rehydration salts ORS and zinc on private sector supply chains, like that of Coca-Cola’s (which makes their product readily available in rural areas), can play a crucial role in improving availability, awareness, access, and utilization of simple medicines which may not be readily available (i.e. due to stock outs, distances to access points, opportunity costs, etc.), either in the public or private sector.
The new commodity ‘Kit Yamoyo’ (Life-giving Kit) is sold by existing rural micro-retailers, trained and registered by the project. The project’s ‘end-to-end’ value chain enables profit to be made at every step. A voucher system supports tracking and acts as a marketing incentive ( 60-70% of customers may try the product for free during the trial).
The project purpose is to improve access; ie an anti-diarrhoea kit in the hands of and aware mother/care-giver.
Outputs are:
- improved availability to rural mothers/carers of under fives, through harnessing a profit driven supply chain to improve availability of an anti-diarrhoea kit
- improved awareness of the anti-diarrhoea kit and its benefits, amongst mothers/care-givers (including benefits of contents: ORS, Zinc and Soap)
Amongst impacts, we will look at:
- distances walked by mothers to access ORS/Zinc
- reported treatment delay
- reported knowledge/awareness of the pack (and ORS/Zinc)
- small rural shops/livelihoods
- stock levels
- reported use of ORS/Zinc
- costs
